14 Mar Confused about PCOS?
Look, I don’t blame you.
You’ve probably read about insulin resistance, being overweight, and meeting other kinds of polycystic ovary syndrome criteria. Your doctor might have even done an ultrasound, saw a few cysts on your ovaries and used that alone to drop the PCOS bombshell.
Whilst you’re picking up the pieces, can we clarify a couple of things?
Firstly, a proper PCOS diagnosis requires evidence of elevated testosterone or other male hormones (like DHEA or androstenedione) – ideally with a blood draw and not just symptoms.
Secondly, as Dr Marilyn Glenville explains, these aren’t cysts at all but rather underdeveloped follicles on the ovaries – they look like a string of pearls or bunch of grapes on the ultrasound. Each month, there should be around 6 – 12 developing follicles, with one being ‘dominant’ – that’s the one that progresses to ovulation. However, if there’s no ovulation, instead of having a dominant follicle, there’s loads of small, underdeveloped ones, and that’s what they’re seeing on the ultrasound – if there’s 12 or more of them measuring 2 – 9mm in diameter (with 20mm being normal for a healthy follicle), then this is indicative of PCOS. But an ultrasound scan alone sure as heck ain’t sufficient for a PCOS diagnosis!
Finally, as Dr Lara Briden explains on her healthy hormone blog, Polycystic Ovary Syndrome is an umbrella term for a set of symptoms that all come back to one thing: not ovulating regularly. But root causes for not ovulating differ, and so the way each cause is addressed differs too – hence why it’s so necessary to establish what’s going on for you.
So let’s drop it like it’s hot and break this down: Dr Lara Briden explains that there are 4 different types PCOS.
Beginning with the classic & most common PCOS: Insulin-Resistant PCOS.
Here, we’re talking:
- Borderline diabetes
- High fasting insulin
- Possible elevated luteinizing hormone (LH)
- Being overweight (or as I prefer to say: badass babes who’re all about that base) BUT
- Normal-weight insulin resistance is a thing, and it’s generally linked to eating disorders, dieting or high emotional stress
So if that’s you, together with your healthcare practitioner, you’d want to consider:
- Eating seasonal, single-ingredient, fresh foods
- Including high quality proteins, fats & vegetables in each meal
- Showing sugar the back door
- Eating at set & regular times (or possible intermittent fasting)
- Supplements such as magnesium, chromium picolinate, vitamin D & inositol and herbs such as berberine or black clash (neither of which are to be taken when on The Pill, fertility drugs or HRT or without the guidance of a healthcare practitioner)
- (And no, not the Pill, which only but masks the underlying cause of PCOS – and also worsens insulin sensitivity)
Moving on to what might be considered Inflammatory PCOS or Adrenal-based PCOS
Emotional stress, inflammatory foods, unbalanced blood sugar, environmental toxins and intestinal permeability (or a ‘leaky gut’) aren’t great news for PCOS. Why? Because they’re all a form of stress – so the adrenals come into play, and over time, trigger inflammation. This then disrupts hormone receptors & interferes with ovulation.
So, if your immune system has taken a dive (think recurring infections, skin conditions & joint pain), this might be you. You might be normal weight or even underweight, and you may or may not have the ‘typical’ PCOS symptoms (hairy chin, upper lip & nipples, yo!).
What to do?
Chat with your healthcare practitioner and consider:
- Relaxing (I’d really recommend giving Headspace a go)
- Resting (getting 7 – 9 hours/night of sleep is KEY)
- Reducing exposure to environmental toxins (like those pesky pesticides & that plastic)
- Including anti-inflammatory foods (we’re talking oily fish, curcumin and plenty of phytonutrients) and ditching the pro-inflammatory ones
- Treating intestinal permeability (by a removing, replacing, reinoculating & repairing process)
- Regulating your HPA axis (magnesium is most magnificent for this together with certain adaptogens)
- Don’t overexercise (as this can lead to over-production of cortisol and ain’t nobody got taaaime for too much cortisol with PCOS because it just worsens hormonal imbalances)
- Make sure you’re eating enough to ovulate, especially if you’re underweight
Thirdly, Take into Account Possible Post-Pill PCOS.
What’s going on here?
Basically the Pill, and all other forms of synthetic hormones, suppress ovulation – they interfere with communication between the pituitary gland and the ovaries. When you stop the Pill, you may start ovulating again fairly quickly. But for some women, it can take up to a few months or even years for that to happen.
What to look out for:
- Regular periods BEFORE starting the Pill
- Normal or raised LH on a blood test with
- High-normal prolactin
What can be done?
You’d be looking into addressing basics nutrition & lifestyle factors. Then depending on your blood results, and together with your healthcare practitioner, you’d consider herbs such as Agnus Castus (Vitex). This shouldn’t be taken without guidance from your healthcare practitioner (as various factors come into play) and when they are taken, they should work within about 3 – 4 months.
Finally, a few not-so-obvious factors that can’t be forgotten in relation to PCOS:
- Not eating enough, especially carbs
- Thyroid disease (the ovaries need the thyroid hormone, T3) and
- A zinc deficiency (typically common in vegans & vegetarians)
The take home message?
PCOS comes in a few shapes & sizes, all of which can impact on each other. Once diagnosis has been confirmed, moving forward is a matter of figuring out what’s going on for YOU. And it all takes time – we’re talking anywhere from 6 – 9 months (which granted, is a pretty long time considering that’s how long it takes to make a small human) but it’s so worth it if it means getting your lady landscape flourishing again. But if you need help in that process? My door’s open – let’s chat.